Medicaid expansion battle appears far from finished

Several times a month — sometimes several times a week — Gov. Jay Nixon has been meeting with one group or another to discuss why he thinks Missouri government needs to expand the Medicaid program.

But committees in both the House and Senate last week rejected the expansion proposal, and the Legislature’s top two leaders say that expansion can’t happen without reforms first.

Medicaid is a joint federalstate program that assists lowincome people with their medical costs, using money from both governments — and the expansion is part of the federal Affordable Care Act, derided by many opponents as “Obamacare.”

The federal law envisions states will expand Medicaid eligibility to families who can’t afford health insurance, but have incomes up to 138 percent of the federal poverty level — a number that can change from year to year and also varies based on the total number of people in the family.

Currently, that’s $32,500 a year for a family of four.

Nixon said a new report released last week by the Missouri Hospital Association supports his argument that expanding Medicaid is the “right thing to do,” for the extra families who would be served and for the state as a whole.

After a visit Friday to the Warrensburg Chamber of Commerce — which has joined a number of other local and regional chambers in supporting the expansion effort — the governor issued a news release reminding Missourians that his expansion proposal “would bring $5.7 billion to Missouri and provide health coverage to an additional 300,000 Missourians over the next three years — at no cost to the state.”

The Hospital Association report said failing to strengthen Medicaid would increase uncompensated care costs by $11.1 billion and impose a “hidden health care tax” hike on Missouri businesses and families, with a family of four paying an additional $1,688 between 2014 and 2020, if the state does not expand Medicaid.

“This new report presents a stark choice,” Nixon said. “We can bring our tax dollars back to Missouri to strengthen Medicaid and reduce costs for employers and families — or we can send these dollars to other states and see these costs skyrocket.”

Assistant House Minority Leader Gail McAnn Beatty, D-Kansas City, said Thursday, after lawmakers left the Capitol for spring break: “We have seen no advancement of any kind of health care expansion.

“As we have said before, that creates 24,000 jobs. We’re looking at $8.2 billion in additional federal investment in the state, and $9.6 billion in additional economic activity.

“We do know that without passing this legislation, we have the potential for losing at least 5,000 jobs, and we will lose $4 billion in federal reimbursements for uncompensated care, which will result in about a $1 billion tax for our employers.”

But House Speaker Tim Jones, R-Eureka, said Thursday lawmakers have “not shied away from discussing the Medicaid issue,” and noted state Rep. Jay Barnes, R-Jefferson City, will get a chance to have floor debate on his “Medicaid Transformation” bill at some point after lawmakers return to the Capitol on March 25.

Jones reminded reporters that, while the U.S. Supreme Court upheld the health care law’s constitutionality, “Chief Justice John Roberts’ opinion ... stated that the Medicaid expansion was a ‘may,’ not a ‘shall.’ It is optional for the states.”

Senate President Pro Tem Tom Dempsey, R-St. Charles, added: “What we’re asking for is flexibility for the state to design its own solution — we do not believe it’s prudent to double-down on a broken system.”

Dempsey and other Senate GOP leaders — including Sens. Mike Kehoe, Jefferson City, and Kurt Schaefer, Columbia — sent Nixon a letter last week reminding him: “The state already spends nearly half of all state general revenue on the (current) Medicaid program. An expansion of such a large program with a partner as unreliable as the federal government would likely mean future tax increases or serious cuts to vital priorities, like K-12 education.”

Jones said he and Nixon “have had several conversations about Medicaid, and I believe he understands where, philosophically, the General Assembly is, as a singular unit.”

Nixon issued a statement Friday: “I am encouraged that members of the House and Senate are looking at this issue and share my interest in reform, because that is what strengthening Medicaid will do.

“Bringing these dollars back to Missouri will give us an opportunity to reduce premiums, reward hard work, promote personal responsibility and make sure emergency rooms are for real emergencies.

“Strengthening Medicaid also will help people with severe mental illness get the care they need, before they become a threat to themselves or others.”